Yaşlı yetişkinlerde osteoporoz tedavisinde antirezorptif ajanların karşılaştırılması

Year 2022, Volume: 47 Issue: 3, 1248 - 1255, 30.09.2022

Eyyüp Murat Efendioğlu , Ahmet Çiğiloğlu , Sencer Ganidağlı , Zeynel Abidin Öztürk

https://doi.org/10.17826/cumj.1134584

Abstract

Amaç: Yaşlı popülasyonda anti-osteoporotik ilaçların etkinliğini karşılaştıran az sayıda çalışma bulunmaktadır. Bu çalışmada yaşlı yetişkinlerde alendronat, zoledronik asit ve denosumabın etkinliğini karşılaştırmayı amaçladık.
Gereç ve Yöntem: Bu retrospektif çalışmaya 65 yaş ve üzeri osteoporozlu toplam 350 yaşlı dahil edildi. Alendronat, zoledronik asit ve denosumab alan hasta sayısı sırasıyla 111, 121 ve 118 idi. Kemik mineral yoğunluğu (KMY) başlangıçta ve 24. ayda çift enerjili x-ışını absorpsiyometri (DXA) taramaları yapılarak ölçüldü.
Bulgular: Hastaların yaşı, komorbiditeleri ve laboratuvar analiz sonuçları benzerdi. Tedavi grupları arasında femur boynunda KMY yanıtında istatistiksel olarak anlamlı bir fark bulunmazken (alendronat, zoledronik asit ve denosumab için başlangıç KMY'leri sırasıyla 0,61, 0,59 ve 0,58 iken 24. ay KMY'leri sırasıyla 0,62, 0,60 ve 0,59 idi), alendronat ve zoledronik asitin lomber omurga KMY'sini denosumab'dan daha fazla iyileştirdiğini bulduk (alendronat, zoledronik asit ve denosumab için başlangıç KMY'leri sırasıyla 0,74, 0,74 ve 0,71 iken, 24. ay KMY'leri sırasıyla 0,77, 0,78 ve 0,73 idi).
Sonuç: Bu çalışma, parenteral antirezorptif ajanlar gibi, alendronatın da yaşlı osteoporotik yetişkinlerde istenilen KMY yanıtını ortaya çıkarabildiğini göstermiştir. Çalışmamızın sonuçları yaşlı bireylerde osteoporoz tedavisine rehberlik edebilir.

Keywords

Yaşlı yetişkinler, osteoporoz, alendronat, zoledronik asit, denosumab

Comparison of antiresorptive agents in the treatment of osteoporosis in older adults

Abstract

Purpose: There are few studies comparing the effectiveness of anti-osteoporotic drugs among elderly population. In this study, we aimed to compare the effectiveness of alendronate, zoledronic acid, and denosumab in older adults.
Materials and Methods: A total of 350 older adults with osteoporosis, aged 65 and over were included in this retrospective study. The number of patients receiving alendronate, zoledronic acid, and denosumab was 111, 121, and 118, respectively. Bone mineral density (BMD) was measured at baseline and 24th month by performing dual-energy x-ray absorptiometry (DXA) scans.
Results: The age, comorbidities, and laboratory analysis results of the patients were similar. While there was no statistically significant difference in BMD response at the femoral neck between the treatment groups (Baseline BMDs for alendronate, zoledronic acid, and denosumab were 0.61, 0.59, and 0.58, respectively, while 24th month BMDs were 0.62, 0.60, and 0.59, respectively), alendronate and zoledronic acid improved lumbar spine BMD more than denosumab (Baseline BMDs for alendronate, zoledronic acid, and denosumab were 0.74, 0.74, and 0.71, respectively, while 24th month BMDs were 0.77, 0.78, and 0.73).
Conclusion: This study has shown that, like parenteral antiresorptive agents, alendronate can elicit a desirable BMD response in older osteoporotic adults. The results of our study may guide osteoporosis treatment in older individuals.

Keywords

Older adults, osteoporosis, alendronate, zoledronic acid, denosumab

References

• Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int a J Establ as result Coop between Eur Found Osteoporos Natl Osteoporos Found USA. 2014 Oct;25(10):2359–81.
• Adami S, Bertoldo F, Brandi ML, Cepollaro C, Filipponi P, Fiore E, et al. [Guidelines for the diagnosis, prevention and treatment of osteoporosis]. Reumatismo. 2009;61(4):260–84.
• Kanis JA. Assessment of osteoporosis at the primary health-care level. Technical Report [Internet]. Available from: http//www. shef. ac. uk/FRAX, 2008
• Bone HG, Hosking D, Devogelaer J-P, Tucci JR, Emkey RD, Tonino RP, et al. Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004 Mar;350(12):1189–99.
• Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007 May;356(18):1809–22.
• Lacey DL, Boyle WJ, Simonet WS, Kostenuik PJ, Dougall WC, Sullivan JK, et al. Bench to bedside: elucidation of the OPG-RANK-RANKL pathway and the development of denosumab. Nat Rev Drug Discov. 2012 May;11(5):401–19.
• Bone HG, Wagman RB, Brandi ML, Brown JP, Chapurlat R, Cummings SR, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomized FREEDOM trial and open-label extension. lancet Diabetes Endocrinol. 2017 Jul;5(7):513–23.
• Lin T, Wang C, Cai X-Z, Zhao X, Shi M-M, Ying Z-M, et al. Comparison of clinical efficacy and safety between denosumab and alendronate in postmenopausal women with osteoporosis: a meta-analysis. Int J Clin Pract. 2012 Apr;66(4):399–408.
• Pedersen AB, Heide-Jørgensen U, Sørensen HT, Prieto-Alhambra D, Ehrenstein V. Comparison of Risk of Osteoporotic Fracture in Denosumab vs Alendronate Treatment Within 3 Years of Initiation. JAMA Netw open. 2019 Apr;2(4):e192416.
• Weinstein RS. Glucocorticoid-induced osteoporosis and osteonecrosis. Endocrinol Metab Clin North Am. 2012 Sep;41(3):595–611.
• Kanis JA, McCloskey E V, Johansson H, Strom O, Borgstrom F, Oden A. Case finding for the management of osteoporosis with FRAX--assessment and intervention thresholds for the UK. Osteoporos Int a J Establ as result Coop between Eur Found Osteoporos Natl Osteoporos Found USA. 2008 Oct;19(10):1395–408.
• Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int a J Establ as result Coop between Eur Found Osteoporos Natl Osteoporos Found USA. 2007 Aug;18(8):1033–46.
• Rizzoli R, Greenspan SL, Bone G 3rd, Schnitzer TJ, Watts NB, Adami S, et al. Two-year results of once-weekly administration of alendronate 70 mg for the treatment of postmenopausal osteoporosis. J bone Miner Res Off J Am Soc Bone Miner Res. 2002 Nov;17(11):1988–96.
• Nakamura T, Fukunaga M, Nakano T, Kishimoto H, Ito M, Hagino H, et al. Efficacy and safety of once-yearly zoledronic acid in Japanese patients with primary osteoporosis: two-year results from a randomized placebo-controlled double-blind study (ZOledroNate treatment in Efficacy to osteoporosis; ZONE study). Osteoporos Int a J Establ as result Coop between Eur Found Osteoporos Natl Osteoporos Found USA. 2017 Jan;28(1):389–98.
• Reid DM, Devogelaer J-P, Saag K, Roux C, Lau C-S, Reginster J-Y, et al. Zoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis (HORIZON): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet (London, England). 2009 Apr;373(9671):1253–63.
• Wu J, Zhang Q, Yan G, Jin X. Denosumab compared to bisphosphonates to treat postmenopausal osteoporosis: a meta-analysis. J Orthop Surg Res. 2018 Aug;13(1):194.
• Lyu H, Jundi B, Xu C, Tedeschi SK, Yoshida K, Zhao S, et al. Comparison of Denosumab and Bisphosphonates in Patients With Osteoporosis: A Meta-Analysis of Randomized Controlled Trials. J Clin Endocrinol Metab. 2019 May;104(5):1753–65.
• Migliorini F, Maffulli N, Colarossi G, Eschweiler J, Tingart M, Betsch M. Effect of drugs on bone mineral density in postmenopausal osteoporosis: a Bayesian network meta-analysis. J Orthop Surg Res. 2021 Aug;16(1):533.
• Cummings SR, Karpf DB, Harris F, Genant HK, Ensrud K, LaCroix AZ, et al. Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med. 2002 Mar;112(4):281–9.
• Bouxsein ML, Eastell R, Lui L-Y, Wu LA, de Papp AE, Grauer A, et al. Change in Bone Density and Reduction in Fracture Risk: A Meta-Regression of Published Trials. J bone Miner Res Off J Am Soc Bone Miner Res. 2019 Apr;34(4):632–42.
• Hochberg MC, Ross PD, Black D, Cummings SR, Genant HK, Nevitt MC, et al. Larger increases in bone mineral density during alendronate therapy are associated with a lower risk of new vertebral fractures in women with postmenopausal osteoporosis. Fracture Intervention Trial Research Group. Arthritis Rheum. 1999 Jun;42(6):1246–54.
• Cranney A, Wells G, Willan A, Griffith L, Zytaruk N, Robinson V, et al. Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev. 2002 Aug;23(4):508–16.
• Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009 Aug;361(8):756–65.
• Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet (London, England). 1996 Dec;348(9041):1535–41.
• Thomas T, Horlait S, Ringe JD, Abelson A, Gold DT, Atlan P, et al. Oral bisphosphonates reduce the risk of clinical fractures in glucocorticoid-induced osteoporosis in clinical practice. Osteoporos Int a J Establ as result Coop between Eur Found Osteoporos Natl Osteoporos Found USA. 2013 Jan;24(1):263–9.
• Abelson A, Ringe JD, Gold DT, Lange JL, Thomas T. Longitudinal change in clinical fracture incidence after initiation of bisphosphonates. Osteoporos Int a J Establ as result Coop between Eur Found Osteoporos Natl Osteoporos Found USA. 2010 Jun;21(6):1021–9
• Coyle D. Cost-Effectiveness of Pharmacological Treatments for Osteoporosis Consistent with the Revised Economic Evaluation Guidelines for Canada. MDM policy Pract. 2019;4(1):2381468318818843.